Week ending May 23, 2020 Epidemiological Week 21 WEEKLY ......Likewise vaccine prevention and experimental treatment should be offered under the same conditions as for non-pregnant

Week ending May 23, 2020 Epidemiological Week 21

WEEKLY EPIDEMIOLOGY BULLETIN NATIONAL EPIDEMIOLOGY UNIT, MINISTRY OF HEALTH & WELLNESS, JAMAICA

EPI WEEK 21

Ebola virus disease

The Ebola virus causes an acute, serious illness which is often fatal if untreated. EVD first appeared

in 1976 in 2 simultaneous outbreaks, one in what is now Nzara, South Sudan, and the other in

Yambuku, DRC. The latter occurred in a village near the Ebola River, from which the disease takes its

name. The 2014–2016 outbreak in West Africa was the largest Ebola outbreak since the virus was

first discovered in 1976. The outbreak started in Guinea and then moved across land borders to

Sierra Leone and Liberia. The current 2018-2019 outbreak in eastern DRC is highly complex, with

insecurity adversely affecting public health response activities.

The virus family Filoviridae includes three genera: Cuevavirus, Marburgvirus, and Ebolavirus. Within

the genus Ebolavirus, six species have been identified: Zaire, Bundibugyo, Sudan, Taï Forest, Reston

and Bombali. The virus causing the current outbreak in DRC and the 2014–2016 West African

outbreak belongs to the Zaire ebolavirus species.

Key facts

• Ebola virus disease (EVD), formerly known as Ebola haemorrhagic fever, is a rare but severe, often fatal illness in humans.

• The virus is transmitted to people from wild animals and spreads in the human population through human-to-human transmission.

• The average EVD case fatality rate is around 50%. Case fatality rates have varied from 25% to 90% in past outbreaks.

• Community engagement is key to successfully controlling outbreaks.

• Good outbreak control relies on applying a package of interventions, namely case management, infection prevention and control practices, surveillance and contact tracing, a good laboratory service, safe and dignified burials and social mobilisation.

• Vaccines to protect against Ebola are under development and have been used to help control the spread of Ebola outbreaks in Guinea and in the Democratic Republic of the Congo (DRC).

• Early supportive care with rehydration, symptomatic treatment improves survival. There is no licensed treatment proven to neutralize the virus but a range of blood, immunological and drug therapies are under development.

• Pregnant and breastfeeding women with Ebola should be offered early supportive care. Likewise vaccine prevention and experimental treatment should be offered under the same conditions as for non-pregnant population.

https://www.who.int/news-room/fact-sheets/detail/ebola-virus-

disease

SYNDROMES PAGE 2

CLASS 1 DISEASES PAGE 4

INFLUENZA PAGE 5

DENGUE FEVER PAGE 6

GASTROENTERITIS PAGE 7

RESEARCH PAPER PAGE 8

https://www.who.int/news-room/fact-sheets/detail/ebola-virus-disease

https://www.who.int/news-room/fact-sheets/detail/ebola-virus-disease

Released June 5, 2020 ISSN 0799-3927

NOTIFICATIONS-

All clinical

sites

INVESTIGATION

REPORTS- Detailed Follow

up for all Class One Events

HOSPITAL

ACTIVE

SURVEILLANCE-30 sites. Actively pursued

SENTINEL

REPORT- 78 sites.

Automatic reporting

2

SENTINEL SYNDROMIC SURVEILLANCE Sentinel Surveillance in

Jamaica

Map representing the Timeliness of Weekly Sentinel Surveillance Parish Reports for the Four Most Recent Epidemiological Weeks – 18 to 21 of 2020 Parish health departments submit reports weekly by 3 p.m. on Tuesdays. Reports submitted after 3 p.m. are considered late.

FEVER Temperature of >380C /100.40F (or recent history of fever) with or without an obvious diagnosis or focus of infection.

KEY VARIATIONS OF BLUE SHOW CURRENT WEEK

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Weekly Visits to Sentinel Sites for Undifferentiated Fever All ages: Jamaica, Weekly Threshold vs Cases 2020

2020 <5 2020 ≥5 Epidemic Threshold <5 Epidemic Threshold >=5

A syndromic surveillance system is good for early detection of and response to public health events. Sentinel surveillance occurs when selected health facilities (sentinel sites) form a network that reports on certain health conditions on a regular basis, for example, weekly. Reporting is mandatory whether or not there are cases to report. Jamaica’s sentinel surveillance system concentrates on visits to sentinel sites for health events and syndromes of national importance which are reported weekly (see pages 2 -4). There are seventy-eight (78) reporting sentinel sites (hospitals and health centres) across Jamaica.

REPORTS FOR SYNDROMIC SURVEILLANCE


NOTIFICATIONS-

All clinical

sites

INVESTIGATION



HOSPITAL

ACTIVE


SENTINEL

REPORT- 78 sites.

Automatic reporting

3

FEVER AND NEUROLOGICAL Temperature of >380C /100.40F (or recent history of fever) in a previously healthy person with or without headache and vomiting. The person must also have meningeal irritation, convulsions, altered consciousness, altered sensory manifestations or paralysis (except AFP).

FEVER AND HAEMORRHAGIC Temperature of >380C /100.40F (or recent history of fever) in a previously healthy person presenting with at least one haemorrhagic (bleeding) manifestation with or without jaundice.

FEVER AND JAUNDICE Temperature of >380C /100.40F (or recent history of fever) in a previously healthy person presenting with jaundice. The epidemic threshold is used to confirm the emergence of an epidemic in order to implement control measures. It is calculated using the mean reported cases per week plus 2 standard deviations.

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Weekly Visits to Sentinel Sites for Fever and Neurological Symptoms 2019 and 2020 vs. Weekly Threshold: Jamaica

2019 2020 Alert Threshold Epidemic Threshold

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Fever and Jaundice cases: Jamaica, Weekly Threshold vs Cases 2019 and 2020



NOTIFICATIONS-

All clinical

sites

INVESTIGATION



HOSPITAL

ACTIVE


SENTINEL

REPORT- 78 sites.

Automatic reporting

4

ACCIDENTS Any injury for which the cause is unintentional, e.g. motor vehicle, falls, burns, etc.

KEY VARIATIONS Of BLUE SHOW CURRENT WEEK

VIOLENCE Any injury for which the cause is intentional, e.g. gunshot wounds, stab wounds, etc.

GASTROENTERITIS Inflammation of the stomach and intestines, typically resulting from bacterial toxins or viral infection and causing vomiting and diarrhoea.

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500

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Weekly visits to Sentinel Sites for Accidents by Age Group 2020 vs Weekly Threshold; Jamaica

≥5 Cases 2020 <5 Cases 2020 Epidemic Threshold<5 Epidemic Threshold≥5

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100

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Weekly visits to Sentinel Sites for Violence by Age Group 2020 vs Weekly Threshold; Jamaica

≥5 y.o <5 y.o

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Weekly visits to Sentinel Sites for Gastroenteritis All ages 2020 vs Weekly Threshold; Jamaica

2020 <5 2020 ≥5 Epidemic Threshold <5 Epidemic Threshold >5


NOTIFICATIONS-

All clinical

sites

INVESTIGATION



HOSPITAL

ACTIVE


SENTINEL

REPORT- 78 sites.

Automatic reporting

5

CLASS ONE NOTIFIABLE EVENTS Comments

Confirmed YTD AFP Field Guides

from WHO indicate

that for an effective

surveillance system,

detection rates for

AFP should be

1/100,000

population under 15

years old (6 to 7)

cases annually.

___________

Pertussis-like

syndrome and

Tetanus are

clinically confirmed

classifications.

______________

* Dengue

Hemorrhagic Fever

data include Dengue

related deaths;

** Figures include

all deaths associated

with pregnancy

reported for the

period. * 2019 YTD

figure was updated.

*** CHIKV IgM

positive

cases

**** Zika

PCR positive cases

CLASS 1 EVENTS CURRENT

YEAR 2020 PREVIOUS

YEAR 2019

NA

TIO

NA

L /

INT

ER

NA

TIO

NA

L

INT

ER

ES

T

Accidental Poisoning 5 6

Cholera 0 0

Dengue Hemorrhagic Fever* NA NA

Hansen’s Disease (Leprosy) 0 0

Hepatitis B 0 8

Hepatitis C 0 2

HIV/AIDS NA NA

Malaria (Imported) 0 0

Meningitis (Clinically confirmed) 1 5

EXOTIC/

UNUSUAL Plague 0 0

H I

GH

MO

RB

IDIT

/

MO

RT

AL

IY

Meningococcal Meningitis 0 0

Neonatal Tetanus 0 0

Typhoid Fever 0 0

Meningitis H/Flu 0 0

SP

EC

IAL

PR

OG

RA

MM

ES

AFP/Polio 0 0

Congenital Rubella Syndrome 0 0

Congenital Syphilis 0 0

Fever and

Rash

Measles 0 0

Rubella 0 0

Maternal Deaths** 14 27

Ophthalmia Neonatorum 23 93

Pertussis-like syndrome 0 0

Rheumatic Fever 0 0

Tetanus 0 0

Tuberculosis 0 11

Yellow Fever 0 0

Chikungunya*** 0 0

Zika Virus**** 0 0 NA- Not Available


NOTIFICATIONS-

All clinical

sites

INVESTIGATION



HOSPITAL

ACTIVE


SENTINEL

REPORT- 78 sites.

Automatic reporting

6

NATIONAL SURVEILLANCE UNIT

INFLUENZA REPORT EW 21

May 17 2020-May 23, 2020 Epidemiological Week 21

EW 21 YTD

SARI cases 15 279

Total

Influenza

positive Samples

0 69

Influenza A 0 45

H3N2 0 4

H1N1pdm09 0 38

Not subtyped 0 3

Influenza B 0 24

Parainfluenza 0 0

Epi Week Summary

During EW 21, 15 (fifteen) SARI

admissions were reported.

Caribbean Update EW 21

Caribbean: Overall, influenza activity was

elevated in the sub-region. In Cuba, influenza

activity increased with influenza A and B viruses

co-circulating. Influenza activity decreased in

Belize with influenza A(H1N1)pdm09 and influenza B viruses co-circulating. All the French

Territories are in the epidemic phase with a

continued increase in influenza activity observed in Guadeloupe and Martinique. In Saint-

Barthélémy influenza activity was stable. In the

Dominican Republic, influenza activity slightly decreased with influenza A(H1N1)pdm09

predominance and influenza B/Yamagata co-

circulating. In Saint Lucia, influenza-like illness was above the epidemic threshold with influenza

A(H1N1)pdm09 virus circulating in recent weeks.

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2500

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Weekly visits to Sentinel Sites for Influenza-like Illness (ILI) All ages 2020 vs Weekly Threshold; Jamaica

2020 2020 2020

Epidemic Threshold <5 Epidemic Threshold 5-59 Epidemic Threshold ≥60

Epidemiologic week

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Epidemiological Week

Jamaica: Percentage of Hospital Admissions for Severe Acute Respiratory Illness (SARI 2020) (compared with 2011-2019)

SARI 2020 Alert ThresholdAverage epidemic curve (2011-2019) Seasonal Threshold

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EPIDEMIOLOGIC WEEK

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OSI

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LES

D I S T R I B U T I O N O F I N F L U E N Z A A N D O T H E R R E S P I R A T O R Y V I R U S E S I N S U R V E I L L A N C E B Y E W

A(H1N1)pdm09 A not subtyped A no subtypable A(H1)

A(H3) Parainfluenza RSV Adenovirus

Methapneumovirus Rhinovirus Coronavirus Bocavirus


NOTIFICATIONS-

All clinical

sites

INVESTIGATION



HOSPITAL

ACTIVE


SENTINEL

REPORT- 78 sites.

Automatic reporting

7

Dengue Bulletin May 17, 2020-May 23, 2020 Epidemiological Week 21 Epidemiological Week 21

Reported suspected and confirmed dengue

with symptom onset in week 21 of 2020

2020

EW 21

YTD

Total Suspected Dengue

Cases 0** 589**

Lab Confirmed Dengue cases

0** 1**

CONFIRMED Dengue Related Deaths

0** 1**

Points to note:

• ** figure as at May 27 , 2020

• Only PCR positive dengue cases

are reported as confirmed.

• IgM positive cases are classified

as presumed dengue.

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2020 Epidemic threshold

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NOTIFICATIONS-

All clinical

sites

INVESTIGATION



HOSPITAL

ACTIVE


SENTINEL

REPORT- 78 sites.

Automatic reporting

8

10

368

591

213

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Confirmed Active Recovered Died

Clinical Status of Confirmed Cases (n=591)

(36%)

(62.3%)(1.7%)

COVID-19 Epidemiological Report

Data as at June 4, 2020

Key Points

o Jamaica has reported 591 confirmed cases of

COVID-19

- 92 imported

- 27 local transmissions (not epidemiologically linked)

- 217 contacts of a confirmed case

- 235 related to a work place cluster

- 20 under investigation

o All parishes have reported cases

o Cumulative Incidence - 21.7 per 100,000 population

o ACTIVE cases - 213 (36%)

- 2 critically ill

o DEATHS - 10 (1.7%)

o RECOVERIES - 368 (62.3%)

Contact of a Confirmed Case, 217,

37%

Work Place Cluster, 235,

40%

Under Investigation,

20, 3%

Local Transmission (Not Epi Linked), 27, 5%

Imported Prior to April 21, 2020, 34, 6%

Imported Cruise Ships,

34, 6%

Imported UK Flight, 15, 2%

Imported USA Flights, 9, 1%

Imported After April 21, 2020 9%

Source of Infection, Jamaica as at June 4, 2020

As at April 20, 2020 there have been 2320 re-entries;

All have been tested with 58 positives cases to date

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Number of Confirmed COVID-19 Cases, Recoveries and Deaths, Jamaica from March 15, 2020 to June 4, 2020

Confiirmed Cases Recoveries Deaths


NOTIFICATIONS-

All clinical

sites

INVESTIGATION



HOSPITAL

ACTIVE


SENTINEL

REPORT- 78 sites.

Automatic reporting

9

RESEARCH PAPER ABSTRACT

Assessment of the gut microbiome composition of healthy undergraduate science students at the

University of the West Indies, Mona, Jamaica.

R.C. Grant1, P.D. Brown1, Y.D. Niu2 1Department of Basic Medical Sciences, Biochemistry Section, Faculty of Medical Sciences, University of the West Indies, Mona Jamaica, 2Department of

Ecosystem and Public Health, Faculty of Veterinary Medicine, University of Calgary, Canada.

Background: The gut microbiome is a diverse ecosystem with 1014 bacterial cells in symbiotic relationship with their host and are

essential in maintaining a healthy status. These bacteria have also been implicated in diseases such as inflammatory bowel

disease, irritable bowel syndrome, obesity and diabetes. The gut microbiome is generally stable but can be affected by factors

such as culture, diet, geography and demographics.

Objectives: Consequently, this pilot study sought to assess the gut microbiome composition of healthy undergraduate science

students, ages 18 to 30, attending The University of the West Indies, Mona, Jamaica with a view to leverage this understanding to

promote students’ health.

Methods: After obtaining ethical approval, participants were asked to provide written consent and responses to a questionnaire

and a stool sample. Total DNA was extracted and purified from stool samples, PCR amplified and sequenced.

Results: Firmicutes, Bacteroides, Proteobacteria, and Actinobacteria were the most abundant phyla observed, with Firmicutes in

the highest proportion. Generally, the organisms in the proportions observed, were indicative of a healthy status in the population

of students sampled. However, higher proportion of Firmicutes relative to Bacteroides are known to be associated with obesity

and overweight, which have significant risk for cardiovascular complications.

Conclusion: Comparisons such as body mass index, gender, area of residence, vaginal vs Caesarian section birth, or whether

vegetarian or not, did not show any significant differences in population diversity. Given the current knowledge base, these

assessments can assist in the improvement and maintenance of health and wellness and are becoming important in preventive

medicine.

_____________________________________________________________________________________

The Ministry of Health and Wellness

24-26 Grenada Crescent

Kingston 5, Jamaica

Tele: (876) 633-7924

Email: [email protected]

Week ending May 23, 2020 Epidemiological Week 21 WEEKLY ......Likewise vaccine prevention and experimental treatment should be offered under the same conditions as for non-pregnant

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